Form HSNS APL 02

[See rule 27]

Form of appeal to Appellate Tribunal under ¹[section 30]₁ of the Act

IN THE CUSTOMS, EXCISE AND SERVICE TAX APPELLATE TRIBUNAL

APPEAL No……………………… of ………………20

…………………………………………………………………………………………Appellant

Vs

…………………..…………………………………………………………………Respondent

 1 (i) Registration No.  …………………..

(ii) Jurisdictional Range/ Division / Commissionerate / Zone

(iii) E-mail Address

(iv) Phone No.

2. The designation and address of the authority passing the order appealed against.

3. Number and date of the order appealed against.

Dated

4. Date of communication of a copy of the order appealed against.  

5. State or Union territory and the Commissionerate in which the order or decision of assessment, penalty, fine was made.

6. If the order appealed against relates to more than one Commissionerate, mention the names of all the Commissionerates, so far as it relates to the appellant.

7. Designation and address of the adjudicating authority in case where the order appealed against is an order of the Commissioner (Appeals).

8. Address to which notices may be sent to the appellant

9. Address to which notices may be sent to the respondent.

10. Whether the decision or order appealed against involves any question having a relation to computation of cess.

11. Description and classification of goods

12. Period of dispute.

13. (i) Amount of cess, if any, demanded for the period of dispute .

(ii) Amount of interest involved up to the date of the order appealed against.  

(iii) Amount of refund, if any, rejected or disallowed for the period of dispute

(iv) Amount of fine imposed.

(v) Amount of penalty imposed.

(vi) Market value of seized goods.  

14. (i) Amount of cess or fine or penalty or interest deposited. If so, inform the amount deposited under each head in the box below. (A copy of the challan under which the deposit is made shall be uploaded)

 (ii) If not, whether any application for dispensing with such deposit has been made

15. If the appeal is against an Order-in-Appeal of Commissioner (Appeals), the number of Orders-in-Original covered by the said Order-in-Appeal.

16. Whether the respondent has also filed appeal against the order against which this appeal is made?

17. If answer to serial number 16 above is ‘yes’, upload   the details of the appeal.

18. Whether the appellant wishes to be heard in person?  

19. Reliefs claimed in appeal.

20. Statement of facts

21. Grounds of appeal

Signature of the  Authorised Representative, if any  

Signature of the applicant.

Verification

I, ………………………………… the appellant, do hereby declare that what is stated above is true to the best of my information and belief.

Verified today, the ……….. day of ……………………. 20………

Signature of the  Authorised Representative, if any  

Signature of the applicant.

Notes.- (1) The grounds of appeal and the form of verification shall be signed by the appellant in accordance with rule 27.

(2) The appeal including the statement of facts and the grounds of appeal shall be filed in accompanied by a certified copy of the order appealed against.